Antepartum

barrier methods:

Barrier contraceptives have gained in popularity not only as a contraceptive method but also as protection against the spread of STIs such as human papilloma virus and herpes simplex virus (HSV). The typical failure rate for the use of the male condom is approximately 15%. Spermicide (considered a barrier but does not protect against STI) must be reapplied for each additional act of intercourse, even if a barrier method is used. Studies have shown varying effectiveness rates for spermicidal use alone. The typical failure rate is 15% to 29%

The placenta...

Development: During the third week after conception, the chorion develops from the trophoblast and contains the chorionic villi on its surface. The villi burrow into the decidua basalis and increase in size and complexity as the vascular processes develop into the placenta. structure: A third layer develops into anchoring septa, dividing the projecting decidua into separate areas called cotyledons. In each of the 15 to 20 cotyledons, the chorionic villi branch out and a complex system of fetal blood vessels forms. Each cotyledon is a functional unit. The whole structure is the placenta and working by day 17, when the embryonic heart starts beating! function: •Endocrine gland (produces hCG, progesterone(maintains endometrium), estriol(uterine growth), hCS(lactogen) •Metabolic (lung for fetus) function and waste •Nutrient storage

pregnant patient interventions:

Education: on expected maternal & fetal changes nutritional & personal hygiene prevention of UTI kegel exercises prep for breastfeeding oral health physical activity posture and body mechanics rest and relaxation employment, clothing, travel med and herbs rh immunoglobulin substance use normal discomforts sex counceling

The effect of age on the family to the pregnancy and the prenatal care provided...

The age of childbearing couple has significance on adaptation abilities. Adolescence: ◾less likely to receive adequate prenatal care, often receiving no health care at all. ◾More likely to smoke and less likely to gain adequate weight during pregnancy. ◾Neonates born to adolescents are at increased risk for LBW, VLBW, and infant death. ◾at increased risk for maternal anemia, preterm birth, preeclampsia and/or HELLP syndrome, postpartum hemorrhage, and chorioamnionitis Women older than 35: ◾greater chance of preexisting conditions such as hypertension and diabetes ◾associated with increased risk for miscarriage, stillbirth, diabetes, hypertension, placenta previa, placental abruption, cesarean birth, and pregnancy-related mortality. ◾more likely than younger primiparas to have infants with chromosomal abnormalities, LBW infants, preterm birth, and multiple gestation

Amniotic fluid...

The amniotic cavity initially derives its fluid by diffusion from the maternal blood. Fluid secreted by the respiratory and gastrointestinal tracts of the fetus also enters the amniotic cavity. The amount of fluid increases weekly, and 700 to 1000 mL of transparent liquid is normally present at term. FUNCTIONS: facilitates symmetric growth, allows for muscle development, body temp, sources for oral fluid, barrier to infection, cushions fetus, keeps fetus from entangling w/ membranes, electrolyte homeostasis, allows fetal lung development

Common causes of infertility male...

The basic test for male infertility is semen analysis.

recommended maternal weight gain during pregnancy

The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight-gain recommendation is the appropriateness of the pre pregnancy weight for the woman's height—that is, whether the woman's weight was normal before pregnancy or whether she was underweight or overweight. Prepregnant BMI can be classified into the following categories: less than 18.5, underweight or low; 18.5 to 24.9, normal; 25 to 29.9, overweight or high; and 30 or greater, obese. At the first prenatal visit, the pregnant woman should be helped to establish a weight-gain goal for pregnancy that is suited to her pre pregnancy weight. Progress toward this goal should be monitored at each visit

The impact of culture on childbearing families....

The family and its cultural and spiritual context play an important role in defining the work of maternity nurses. Despite modern stresses and strains, the family forms a social network that acts as a potent support system for its members. The current emphasis in working with families is on wellness and empowerment for families to achieve control over their lives.

pre-natal care

The goal of prenatal care is to promote the health and well-being of the pregnant woman, her fetus, the newborn, and the family. It includes education about healthy lifestyle behaviors such as nutrition and physical activity, self-care for the common pregnancy discomforts, and information about changes in the mother and growth of the developing fetus. Routine screening is offered during pregnancy to help identify existing risk factors and potential problems so that efforts to reduce risk for harm to mother or baby and management of identified conditions can be initiated at the earliest opportunity.

Choices for childbirth: midwife

The midwifery model of care emphasizes the natural ability of women to experience pregnancy, labor, and birth with minimal intervention. The services provided by midwives are dependent on their licensing and certification as well as the practice regulations in each state. There are three types of credentialed professional midwives: certified nurse midwives (CNM), certified midwives (CM), and certified professional midwives (CPM

Health screening schedule for women

To promote wellness and prevent illness, it is imperative that women adhere to specific screening guidelines to detect conditions that, if found early, are amenable to treatment and/or cure. Table 3.1

Maternal physiologic & anatomic adaptations

are attributed to the hormones of pregnancy and to mechanical pressures arising from the enlarging uterus and other tissues. • Presumptive—Subjective changes reported by the woman (e.g., amenorrhea, fatigue, breast changes). These can be caused by conditions other than pregnancy. • Probable—Objective changes assessed by an examiner (e.g., Hegar sign, ballottement, pregnancy tests). When combined with the presumptive signs and symptoms, these changes strongly suggest pregnancy. • Positive—Objective signs assessed by an examiner that can be attributed only to the presence of the fetus (e.g., hearing fetal heart tones, visualizing the fetus, palpating fetal movements). These are definitive signs that confirm pregnancy.

The number of fetuses and the effect on family to pregnancy and prenatal care provided...

A multifetal pregnancy, or pregnancy with more than one fetus, places the mother and fetuses at increased risk for adverse outcomes. Maternal physiologic adaptation to pregnancy is more dramatic with multiple fetuses. Multifetal gestation increases the risk for many pregnancy complications including spontaneous abortion, gestational diabetes, hypertension, preeclampsia, placenta previa, and postpartum hemorrhage. Preterm birth is more likely with multifetal gestation;Multiple newborns can place a strain on finances, space, workload, and the woman's and family's coping capabilities. Lifestyle changes can be necessary. Parents need assistance in making realistic plans for the care of the infants

Endometriosis

characterized by the presence and growth of endometrial tissue outside of the uterus. The major symptoms of endometriosis are pelvic pain, dysmenorrhea, and dyspareunia (painful intercourse). Women may also have chronic noncyclic pelvic pain, pelvic heaviness, or pain radiating into the thighs. Many women report bowel symptoms such as diarrhea, pain with defecation, and constipation caused by avoiding defecation because of the pain. Other symptoms include abnormal bleeding (hypermenorrhea, menorrhagia, or premenstrual staining) and pain during exercise as a result of adhesions.

Contraception: fertility awareness method

contraception that depends on identifying the beginning and end of the fertile period of the menstrual cycle. Advantages: low-to-no cost, absence of chemicals and hormones, and lack of alteration in the menstrual flow pattern. Disadvantages: of FAMs include adherence needed for strict record keeping, unintentional interference from external influences that may alter the woman's core body temperature and vaginal secretions, decreased effectiveness in women with irregular cycles, decreased spontaneity of coitus, and the necessity of attending possibly time-consuming training sessions by qualified instructors. The typical failure rate for most FAMs is 24% during the first year of use. FAMs do not protect against STIs or HIV infection.

Papanicolaou (Pap) test

cytological study used to detect abnormal cells sloughed from the cervix and vagina, usually obtained during routine pelvic examination see box 3.13 for procedure

Food sources that provide nutrients required for pregnancy and lactation:

grains, vegetables, fruits, milk, yogurt and cheese, meat, eggs, nuts, beans, oils

Common treatments for infertility...

healthy lifestyle changes that result in a BMI within the normal range Male wear boxer shorts and loose pants Relaxation, osteopathy, stress management pharmacological (hormonal and others) surgical procedures to fix anatomy reproductive assistive therapies

Common causes of infertility female....

is considered to be a diagnosis for couples who have not achieved pregnancy after 1 year of regular, unprotected intercourse when the woman is less than 35 years of age or after 6 months when the woman is older than 35 years of age. Both obesity and being underweight. Signs and symptoms of androgen excess such as excess body hair A history of infections of the genitourinary tract and any signs of infections, especially STIs that could impair tubal patency lack of mobility of the uterus or abnormal contours of the uterus and tubes. see box 5.1

Structures and function of female reproductive system:

labia are highly vascular structures that develop hair on the outer surfaces after puberty. They protect the inner vulvar structures. clitoris is located underneath the prepuce. It is a small structure composed of erectile tissue with numerous sensory nerve endings. Bartholin glands lie under the constrictor muscles of the vagina, glands secrete clear mucus to lubricate the vaginal introitus. The internal structures include the vagina, uterus, uterine tubes (fallopian tubes), and ovaries.

Maternal hormone: Cortisol

originates: Adrenal glands target organ: bloodstream effect: Stimulates production of insulin; increases peripheral resistance to insulin

Maternal hormone: Aldosterone

originates: Adrenal glands target organ: bloodstream effect: Stimulates reabsorption of excess sodium from the renal tubules

Maternal hormone: serum prolactin

originates: Anterior pituitary gland target organ: breast effect: Prepares breasts for lactation

Maternal hormone: Estrogen

originates: Corpus luteum until 14 weeks of gestation, then the placenta target organ: anterior pituitary effect: Suppresses secretion of FSH and LH; causes fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs; promotes enlargement of genitals, uterus, and breasts; increases vascularity; relaxes pelvic ligaments and joints; interferes with folic acid metabolism; increases the level of total body proteins; promotes retention of sodium and water; decreases secretion of hydrochloric acid and pepsin; decreases mother's ability to use insulin

Maternal hormone: Progesterone

originates: Corpus luteum until 14 weeks of gestation, then the placenta target organ: anterior pituitary gland effect: Suppresses secretion of FSH & LH ; maintains pregnancy by relaxing smooth muscles, decreasing uterine contractility; causes fat to deposit in subcutaneous tissues over the maternal abdomen, back, and upper thighs; decreases mother's ability to use insulin

Maternal hormone: Human chorionic gonadotropin (hCG)

originates: Fertilized ovum and chorionic villi target organ: Maintains corpus luteum production of estrogen and progesterone until placenta takes over the function effect: hormone the pregnancy test picks up

Maternal hormone: insulin

originates: Pancreas target organ: bloodstream effect: Increases production of insulin to compensate for insulin antagonism caused by placental hormones; effect of insulin antagonists is to decrease tissue sensitivity to insulin or ability to use insulin

Maternal hormone: parathyroid

originates: Parathyroid glands target organ: bloodstream effect: Controls calcium and magnesium metabolism

Maternal hormone: Human chorionic somatomammotropin (previously called human placental lactogen)

originates: Placenta target organ: blood stream? effect: Acts as a growth hormone; contributes to breast development; decreases maternal metabolism of glucose; increases the amount of fatty acids for metabolic needs

Maternal hormone: Oxytocin

originates: Posterior pituitary gland target organ: Breast and uterus effect: Stimulates uterine contractions; stimulates milk ejection from breasts

Maternal hormone: Thyroxine-binding globulin, thyroxine, triiodothyronine

originates: Thyroid gland target organ: blood stream? effect: With adequate iodine intake, little or no enlargement of thyroid gland. Total T3 and T4 levels are slightly increased, peak by midpregnancy; by term are 10% to 15% lower than nonpregnant

Dysmenorrhea

pain during or shortly before menstruation, is one of the most common gynecologic problems in women of all ages, it has a biochemical basis and arises from the release of prostaglandins with menses.

Gravidity

pregnancy

Gravida

pregnant woman

premenstrual syndrome (PMS)

premenstrual syndrome (PMS) is difficult, given that so many symptoms have been associated with the condition and at least two different syndromes have been recognized: PMS and premenstrual dysphoric disorder (PMDD).(abdominal bloating, pelvic fullness, edema of the lower extremities, breast tenderness, and weight gain), behavioral or emotional changes (depression, crying spells, irritability, panic attacks, and impaired ability to concentrate), premenstrual cravings (sweets, salt, increased appetite, and food binges), headache, fatigue, and backache.

Hypogonadotropic amenorrhea

reflects a problem in the central hypothalamic-pituitary axis, a pituitary lesion or genetic inability to produce follicle-stimulating hormone (FSH) and luteinizing hormone (LH) is at fault. often results from hypothalamic suppression as a result of stress (in the home, school, or workplace) or a sudden and severe weight loss, eating disorders, strenuous exercise, or mental illnes

health screening schedule for women continued...

table continued Table 3.1

Assess nutritional status during pregnancy:

• Nutrition assessment, including of weight and height, and adequacy and quality of dietary intake and habits • Diagnosis of nutrition-related problems or risk factors such as diabetes, phenylketonuria (PKU), and obesity • Interventions based on an individual's dietary goals to promote appropriate weight gain, including ingesting a variety of foods, appropriate use of dietary supplements, and physical activity • Evaluation with referral to a nutritionist or dietitian as necessary

Phases of sexual response:

•Females and males achieve physical maturity at approximately age 17 •First outward appearance of puberty may appear at a much earlier age •Individual development varies greatly •Women and men are more alike than different in physiologic response to sexual excitement and orgasm •Sexual stimulation results in an increase in circulation to circumvaginal blood vessels •Venous congestion is localized primarily in the genitals and to a lesser degree in breasts and other parts of the body •Arousal is characterized by myotonia, resulting in voluntary and involuntary rhythmic contractions The 4 phases are excitement, plateau, orgasm, resolution

Breasts

•Mammary glands •Lactation •Organs for sexual arousal

Parity

•Number of pregnancies in which fetus or fetuses have reached viability, not number of fetuses (e.g., twins) born. Whether the fetus is born alive or is stillborn (fetus who shows no signs of life at birth) after viability is reached does not affect parity

Boney pelvis

•Protection of pelvic structures •Accommodation of growing fetus during pregnancy •Anchorage of pelvic support structures

Primipara:

•Woman who has completed one pregnancy with fetus or fetuses who have reached stage of fetal viability

Nullipara:

•Woman who has not completed a pregnancy with fetus or fetuses who have reached stage of fetal viability

5 Nutritional risk factors during pregnancy

Poverty Two pregnancies within 2 years Use of tobacco alcohol or drugs problems with weight gain diabetes More see box 9.2

Menstrual cycle

(1) the menstrual phase of endometrial cycle: shedding of the functional two thirds of the endometrium, HORMONES: estrogen & progesterone are low, "follicle phase" as FSH and estrogen increase, OVARY: stimulating phase begins as the primary follicle becomes graafian follicle (2) the proliferative phase of endometrial cycle: a period of rapid growth of endometrium lasting from about the fifth day to the time of ovulation, HORMONE estrogen increasing and Lh & FSH spike at ovulation (Day 13 or 14), OVARY: the primary folicle has become a graafian follicle and releases the egg at ovulation (3) the secretory phase of endometrial cycle: extends from the day of ovulation to about 3 days before the next menstrual period. An edematous, vascular, functional endometrium is now apparent. HORMONES: large amounts of progesterone are produced, some estrogen, "luteal phase" egg is corpus luteum (fertilized & implanted or luteum regresses and est. and progest. drop) (4) the ischemic phase of endometrial cycle: the blood supply to the functional endometrium is blocked and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins, marking day 1 of the next cycle. HORMONES: no pregnancy-estrogen and progesterone drop off OVARY: The corpus luteum reaches its peak of functional activity 8 days after ovulation, becomes degenerating corpus luteum

Advantages & disadvantages to Home visits

Advantages Patient can maintain bedrest, if needed. Neonates aren't exposed to environments outside of the home area. The nurse can observe the home environment. Less expensive Disadvantages Travel Limited number of maternity nurses Physical safety of the nurse

Access to Prenatal Care

Although women of middle or high socioeconomic status routinely seek prenatal care, women's reasons for delaying prenatal care include cost, lack of insurance, child care, transportation barriers, or inability to take time off from work. Lack of culturally sensitive care providers, discrimination based on sexual orientation, and barriers to communication resulting from differences in language also interfere with access to care. Likewise, immigrant women who come from cultures in which prenatal care is not emphasized may not know to seek routine prenatal care. The availability of advanced practice nurses (nurse practitioners and certified nurse-midwives [CNM]) as independent providers of care or in collaborative practice with physicians improves the availability and accessibility of prenatal care

Teaching Patient about PMS...

Approximately 75% of women experience premenstrual symptoms at some time in their reproductive lives It is a large number (more than 150) of physical and psychologic symptoms beginning in the luteal phase of the menstrual cycle, occurring to such a degree that lifestyle or work is affected, and followed by a symptom-free period. All age-groups are affected, with women in their twenties and thirties most frequently reporting symptoms The condition is not dependent on the presence of monthly menses: women who have had a hysterectomy without bilateral salpingo-oophorectomy (BSO) still can have cyclic symptoms.

Nursing care plan for primary dysmenorrhea

Assess: Started menarche? Pain before period? Smoke? Obese? Nursing Diagnosis: Primary dysmenorrhea related to cramping, low back pain and wanting to kill someone. Planning: Goal to add three coping mechanisms to the monthly routine to reduce pain from 5 to 2. Interventions: heating pad, ice packs, nonopioid analgesia admin i 4hrs, stretching, and evening walks of 1/2 mile. Evaluation: Pt reports staying at 2 for first 3 days of period. Exercise helped.

Reproductive alternatives for infertile couples...

Couples may choose to build their family by adopting children who are not their own biologically. With increased availability of birth control and abortion and an increase in single mothers who choose to keep their babies, the availability of healthy newborn infants in the United States is limited. Infants with diverse ethnic and racial heritages, infants with special needs, older children, and foreign adoptions are other options . Other alternatives donor eggs or semen, surrogacy, or other reproductive alternatives.

Infertility-ethical, legal, cultural , & religious considerations:

Culturally the prescriptions and taboos for achieving conception may add tension to a couple's sexual functioning. Legal & ethical considerations of cryopreservation of human embryos

the effects of teratogens

Developing areas with rapid cell division are the most vulnerable to malformation (15 days-8weeks) caused by environmental teratogens (substances or exposure that causes abnormal development). The fetus (9weeks to gestation) is less vulnerable to teratogens except for those that affect central nervous system functioning. May affect the embryo or fetus in a number of ways, causing physical malformations, problems in the behavioral or emotional development of the child, and decreased intellectual quotient (IQ) in the child.

The effect of parity on family to the pregnancy and the prenatal care provided..

For multiparous women(having born more than one child) Pregnancy can bring feelings of joy as women consider continuing the maternal role and expanding the family. For some older multiparas, pregnancy can evoke feelings of isolation. She may feel that pregnancy separates her from her peer group and that her age is a hindrance to close associations with young mothers. For primiparous women (preg w/ 1st): Many primigravidas older than 35 years of age deliberately choose parenthood & actively try to prevent fetal disorders and are careful in searching for the best possible maternity care. concerns about having enough energy and stamina to meet the demands of parenting and their new roles and relationships. Adverse perinatal outcomes are more common in older primiparas than in younger women, even when they receive adequate prenatal care. The occurrence of these complications is quite stressful for the new parents, and nursing interventions that provide information and psychosocial support are needed, as well as care for physical needs.

Determine gravidity and parity using 2 and 5 digit systems...

Gravidity and parity information is obtained during history-taking interviews. Gravidity and parity may be described with only two digits: the first digit indicates the number of pregnancies the woman has had, including the present one, and parity the number of pregnancies that have reached 20 weeks or more of gestation. Another system consisting of five digits is commonly used. The first digit represents gravidity (the number of pregnancies), the second digit represents the number of pregnancies that ended in term births (including early, full, late term, or postterm births) at 37 weeks 0 days and beyond, the third indicates the number of pregnancies that ended in preterm birth (between 20 weeks 0 days and 36 weeks 6 days gestation), the fourth identifies the number of pregnancies that ended in miscarriage (spontaneous abortion) or elective termination (therapeutic abortion) before 20 weeks, and the fifth is the number of children currently living. The acronym GTPAL (gravidity, term, preterm, abortions, living children)

Alternative therapies for menstrual disorders...

Heat, Aerobic exercise, Relaxation (Yoga), TENS unit, hypnotherapy, imagery Decreased intake of salt and refined sugar intake 7 to 10 days before expected menses may reduce fluid retention. Natural diuretics such as asparagus, cranberry juice, peaches, parsley, or watermelon may help reduce edema and related discomforts. A low-fat vegetarian diet and vitamin E intake may also help minimize dysmenorrheal symptoms

Where home care fits into continuum of care...

High-risk antepartum care can be provided by home care agencies; for example, women with hyperemesis gravidarum who require parenteral nutrition may be treated at home. Conditions requiring bed rest, such as preterm labor and hypertension, are other common indications for home care. Other conditions often managed with home care include cardiac disease, substance abuse, and diabetes in pregnancy. Preconception care and low-risk antepartum care can usually be provided more efficiently in offices and clinics.

Role of nutritional supplements during pregnancy:

In general, the nutrient needs of pregnant women, with perhaps the exception of folate and iron, can be met through dietary sources.It has been suggested that taking a micronutrient supplement (including vitamins and trace minerals) before and during pregnancy reduces the risk for congenital defects, LBW, and preterm birth, as well as preeclampsia.

Psychological impact of infertility....

Infertility is recognized as a major life stressor that can affect self-esteem; relations with the spouse or partner, family, and friends; and careers. Psychologic responses to the diagnosis of infertility may tax a couple's capacity for giving and receiving physical and sexual closeness. The prescriptions and taboos for achieving conception may add tension to a couple's sexual functioning. They may report decreased desire for intercourse, orgasmic dysfunction, or midcycle erectile disorders.

Education for pregnant patient to recognize potential complications continued...

Information about the physiology, prevention, and self-management of discomforts experienced during the three trimesters is given in Table 8.3. Nurses can do much to allay a first-time mother's anxiety about such symptoms by telling her about them in advance and using terminology that the woman (or couple) can understand.

Pregnant patient & fetal assessments:

Initial visit-prenatal interview health history, OB hx, nutritional hx, med use (+herbals), fam hx social, experimental and occupational hx, mental health screening, Intimate Partner Violence eval, review of systems, physical exam, lab tests, education, breastfeed prep, Fetal gestational age assessment, heart tones, fundal height, amnioscentesis if needed. follow up visits: Physiologic changes are documented as the pregnancy progresses and reviewed for possible deviations from normal progress, ultrasounds, education

Cultural competence in relation to one's own nursing practice...

It is essential that nurses become culturally competent and cognizant of spirituality in its various meanings and interpretations in order to provide appropriate care. Nurses must examine their own beliefs so that they have a better appreciation and understanding of the beliefs of their patients. To promote culturally congruent practice, a new standard has been added to Nursing: Scope and Standards of Practice, 3rd edition (American Nurses Association, 2015b). Standard 8 directs nurses to practice "in a manner that is congruent with cultural diversity and inclusion principles"

The effect of culture on the family to the pregnancy and the prenatal care provided...

Many cultural variations are found in prenatal care. Cultural prescriptions tell women what t o do and cultural proscriptions establish taboo. Some evidence based practice can conflict with these. When exploring cultural beliefs and practices the nurse can support and nurture those beliefs that promote physical or emotional adaptation or sensitively provide education for those that conflict.

Describe the scope of maternity nursing...

Maternity nursing encompasses care of childbearing women and their families through all stages of pregnancy and childbirth and the first 6 weeks after birth. Includes the antepartum, intrapartum, postpartum, and neonatal periods of care.

Genetic disorders commonly tested for in maternity and newborn nursing...

Most of the genetic tests now offered in clinical practice are tests for single-gene disorders in patients with clinical symptoms or who have a family history of a genetic disease. Current prenatal testing options include maternal serum screening (a blood test used to see if a pregnant woman is at increased risk for carrying a fetus with a neural tube defect or a chromosomal abnormality such as DS, trisomy 18, or trisomy 13), fetal ultrasound or sonogram (an imaging technique using high-frequency sound waves to produce images of the fetus inside the uterus), invasive procedures (chorionic villus sampling and amniocentesis), and noninvasive prenatal testing for fetal aneuploidy (a blood test that uses cell-free DNA from the plasma of pregnant women to screen for DS and, in some cases, trisomy 13 and trisomy 18 (see Chapter 10 for more in-depth information). Currently, most states test newborns for 31 core disorders and 26 secondary disorders

Behaviorial changes with pregnancy..

Mother-Emotional changes are common during pregnancy, and therefore asking whether the woman has experienced any mood swings, reactions to changes in her body image, bad dreams, or worries is reasonable. The nurse documents the reactions of the partner and other family members to the pregnancy and the woman's emotional changes.

psychosocial adaptations to pregnancy...

Mother-Her self-concept changes in readiness for parenthood as she prepares for her new role. She moves gradually from being self-contained and independent to being committed to a lifelong concern for another human being. This growth requires mastery of certain developmental tasks: accepting the pregnancy, identifying with the role of mother, reordering the relationships between herself and her mother and between herself and her partner, establishing a relationship with the unborn child, and preparing for the birth experience. Father-Each man brings to pregnancy attitudes that affect the way in which he adjusts to the pregnancy and the parental role. His memories of the fathering he received from his own father, the experiences he has had with child care, and the perceptions of the male and father roles within his social group will guide his selection of the tasks and responsibilities he will assume. The partner's main role in pregnancy is to nurture and respond to the pregnant woman's feelings of vulnerability. Nonpregnant partners will be better prepared for the changes that come with pregnancy and parenting if they are included and considered in the process. Family members-Sharing the spotlight with a new brother or sister can be the first major crisis for a child. The older child often experiences a sense of loss or feels jealous at being "replaced" by the new sibling. Some of the factors that influence the child's response are age, the parents' attitudes, the role of the father, the length of separation from the mother, the facility visitation policy, and the way the child has been prepared for the change.

Contraception-ethical, legal, cultural , & religious considerations:

NFP methods are the only methods of contraception acceptable to the Roman Catholic Church. Legally, All states have strict regulations for informed consent. Many states permit voluntary sterilization of any mature, rational woman without reference to her marital or pregnancy status.

Estimating a due date...

Naegele's rule is a common method for calculating the EDB. It is based on the woman's accurate recall of her last menstrual period (LMP). It assumes that the woman has a 28-day cycle and that fertilization occurred on the 14th day. According to Naegele's rule, after determining the first day of the LMP, subtract 3 calendar months and add 7 days. Only about 5% of women give birth spontaneously on the EDB as determined by Naegele's rule. Most women give birth during the period extending from 7 days before to 7 days after the EDB.

Elective abortion-ethical, legal, cultural , & religious considerations:

Nurses' rights and responsibilities related to caring for abortion patients should be protected through policies that describe how the institution accommodates the nurse's ethical or moral beliefs and what the nurse should do to avoid patient abandonment in such situations. Nurses should know what policies are in place in their institutions and encourage such policies to be written. Nurses and nurse practitioners play an important role in the care of a woman choosing to have an elective abortion. States adapt Roe vs wade to their own dictates.

Pregnancy recommended levels of intake: Pregnancy

Nutrient needs are determined, at least in part, by the stage of gestation. During the first trimester, the synthesis of fetal tissues places relatively few demands on maternal nutrition. In contrast, the last trimester is a period of accelerated fetal growth when most of the fetal stores of energy sources and minerals are deposited. energy sources: 1st tri-same, 2nd tri = +341 kcal (1424 kj), 3rd tri = +452kcal (1892 kJ) protein: 2nd /3rd tri +25 g that's 60 to 70 g per day (higher for multiple gestation). key vitamins: see chart minerals: see chart

Healthy People 2020 goals related to maternal and infant care:

Of the objectives of Healthy People 2020, 33 are related to maternal, infant, and child health (Box 1.2).

Telephonic nursing care options in perinatal nursing...

One alternative that is less expensive is contacting women via telephone or the Internet. Telephonic nursing through services such as warm lines, nurse advice lines, and telephonic nursing assessments is a valuable means of managing health care problems and bridging the gaps among acute, outpatient, and home care services. Health care professionals use the Internet and Skype to communicate with patients.

Choices for childbirth: physicians

Physicians (obstetricians, family medicine physicians) attended 91% of hospital births in the United States in 2015. High-risk pregnant women are often referred to maternal-fetal medicine specialists for part or all of their care.

hormonal methods:

Oral contraceptives do not protect a woman against STIs. The formulations are administered orally, transdermally, vaginally, by implantation, or by injection.

Education for pregnant patient to be able to recognize potential complications:

Pregnant women have physical symptoms that would be considered abnormal in the nonpregnant state. They need explanations of the causes of the discomforts and advice on ways to relieve them. They should report the following: ◾Premature labor could be a concern if the backache is constant, low, and dull and combined with pelvic pressure. ◾Persistent, severe vomiting (flu, food poisoning) ◾Sudden discharge of fluid from vagina before 37 weeks (premature rupture of membranes) ◾Vaginal bleeding, severe abdominal pain (abruption, placenta previa) ◾Chills, fever, burning on urination, diarrhea (urinary tract infection, pyelonephritis) ◾Severe backache or flank pain (urinary tract infection, pyelonephritis) ◾Change in fetal movements, absence of fetal movements, any unusual change in fetal movement pattern (risk for intrauterine demise, low amniotic fluid) ◾Uterine contractions, pressure, cramping before 37 weeks (preterm labor, dehydration) ◾Visual disturbances: blurring vision, double vision, or spots before eyes (high blood pressure, preeclampsia) ◾Swelling of face or fingers and over sacrum (high blood pressure, preeclampsia) ◾Headaches: severe, frequent, or continuous (high blood pressure, preeclampsia) ◾Muscular irritability or convulsions (high blood pressure, eclampsia) ◾Epigastric or abdominal pain (perceived as heartburn) (preeclampsia, HELLP syndrome [hemolysis of red blood cells, elevated liver enzymes, low platelet count]) ◾Glycosuria, positive glucose tolerance test (gestational diabetes)

Education for pregnant patient to recognize potential complications (continued a 3rd PAGE!)

Pregnant women often have difficulty deciding when to report signs and symptoms. The mother is encouraged to refer to the printed list of potential complications and to listen to her body. If she senses that something is wrong, she should call her care provider. Several signs and symptoms must be discussed . These include vaginal bleeding, alteration in fetal movements, symptoms of preeclampsia, rupture of membranes, and preterm labor.

Types of pregnancy tests

Production of β-hCG begins as early as the day of implantation and can be detected in maternal serum or urine as soon as 7 to 8 days before the expected menses. -Urine pregnancy test (most common; first morning urine; detects hCG at 20-50 units/L) -Serum hCG (most sensitive; 1 week after conception; qualitative 5-10 IU/L; quantitative 1-2 IU/L)

Nursing Interventions that facilitate contraceptive use...

Proper instruction in use must be provided, for everything to work properly- never infer people already know. The woman should be taught to check for the presence of the IUD thread after menstruation to rule out expulsion of the device. Because of these wide variations in pills, each woman must be clear about the unique dosage regimen for the preparation prescribed for her and follow directions on the package insert.

The nurse's role in perinatal home care...

Review Box 2.6. In Home Interventions: Systematic assessment of the mother and infant Home environment assessment Safety assessment Education

Pregnant patient nursing diagnoses:

Risk for ineffective role performance possibly evidenced risk factors of maturational crisis, developmental level And history of maladaptive coping. Fatigue /insomnia may be related to increased carb metab, altered body chemistry, inability to maintain usual routines. Impaired comfort may be related to hormonal influences, physical changes as evidenced by verbal reports of nausea, vomiting and leg cramps.

Safety and infection control principles as they apply in the home...

Safety issues Self-awareness Environmental assessment Listening and observation skills Aggressive behaviors Visiting in pairs Have access to a cell phone at all times Infection control Occupational Safety and Health Administration (OSHA) guidelines should be followed Strict handwashing techniques Personal protective equipment (PPE) Proper equipment necessary to prevent the spread of disease is required

Sterilization methods

Sterilization refers to surgical procedures intended to render the person infertile. Most procedures involve the occlusion of the passageways for the ova and sperm. For the woman the uterine tubes are occluded; for the man the sperm ducts (vas deferens) are occluded. This is a very effective and safe method, considered permanent

Growth of the embryo and fetus

The stage of the embryo lasts from day 15 until approximately 8 weeks after conception, when the embryo measures approximately 3 cm from crown to rump. The embryonic stage is the most critical time in the development of the organ systems and the main external features. This stage of the fetus lasts from 9 weeks (when the fetus becomes recognizable as a human being) until the pregnancy ends. Changes during the fetal period are not as dramatic, because refinement of structure and function is taking place.

Tests done at different times during pregnancy

There are a series of laboratory tests that are collected throughout the pregnancy. These tests are either collected at the first prenatal visit or in intervals that are noted in the table based on the gestational age of the fetus. A urine sample is collected at every visit and tested for the presence of protein, glucose, and leukocytes. Any of these would be considered an abnormal finding. Additional blood tests are collected and genetic screening offered at various stages of the pregnancy. The following table provides the laboratory tests that are performed in the prenatal period and at which stage in pregnancy the tests are performed. It is important to understand that there is an appropriate order for blood tests and screenings throughout the pregnancy stages.

Choices for childbirth: Doula

There are primarily two types of doulas involved in the care of childbearing women. The most common is a labor doula who is trained to provide physical, emotional, and informational support to women and their partners during labor and birth. The doula does not become involved with clinical tasks. There are also postpartum doulas who provide support and care for women, newborns, and families during the first weeks after birth. Some doulas are certified by Doula International (DONA) or Childbirth and Postpartum Professional Association (CAPPA), while others provide care without having any certification. A doula typically meets with the woman and her husband or partner during pregnancy. At this meeting, she ascertains the woman's expectations and desires for the birth experience. The doula focuses efforts on assisting the woman to achieve her goals.

Cyclic perimenstrual pain and discomfort (CPPD)

This concept includes dysmenorrhea, premenstrual syndrome (PMS), and premenstrual dysphoric disorder (PMDD) as well as symptom clusters that occur before and after the menstrual flow starts. Symptoms occur cyclically and can include mood swings as well as pelvic pain and physical discomforts

Multipara

Woman who has completed two or more pregnancies to stage of fetal viability

Process of confirming pregnancy...

Women suspect pregnancy when they miss a menstrual period. Many women come to the first prenatal visit after a positive home pregnancy test. The physical cues of pregnancy vary greatly; therefore, the diagnosis of pregnancy is uncertain for a time. Many of the indicators of pregnancy are clinically useful in the diagnosis of pregnancy and are classified as presumptive, probable, or positive (see Table 7.2).

The history and and physical exam can be adapted for women with special needs by...

Women with emotional or physical disorders have special needs. Women who have vision, hearing, emotional, or physical disabilities should be respected and involved in the assessment and physical examination to the full extent of their capabilities. The nurse should communicate openly, directly, and with sensitivity. The assessment and physical examination can be adapted to each woman's individual needs. Examples: avoiding the temptation to speak directly with the interpreter. visually impaired woman needs to be oriented to the examination room, needs a full explanation of what the examination entails before proceeding. adapt the positions to physical ability

Nulligravida

a woman who has never been pregnant

Primigravida

a woman who is pregnant for the first time

Amenorrhea

absence of menstrual flow, is a clinical sign of a variety of disorders, amenorrhea is not a disease, it is often a sign of one, most common sign of pregnancy

water during pregnancy

drink at least 3 L of water per day.

Pregnancy recommended levels of intake: Lactation

energy sources: 1st 6 months+330kcal, 2nd 6 months +400 protein: + 25g key vitamins: see chart minerals: see chart

Birth setting

hospital: Women are admitted to LDR units, labor and give birth, and spend the first 1 to 2 hours postpartum there for immediate recovery and to have time with their families to bond with their newborns. After this period, the mothers and newborns move to a postpartum unit and nursery or mother-baby unit for the duration of their stay. free-standing birthing center: Free-standing birth centers are usually built in locations separate from the hospital but are often located nearby so that quick transfer of the woman or newborn can occur when needed. These birth centers offer families a safe and cost-effective alternative to hospital or home birth. The centers are usually staffed by certified nurse midwives or physicians who also have privileges at the local hospital. Only women at low risk for complications are included for care.. home: The number of planned home births in the United States is gradually increasing. while women have the option of making an informed decision about where they will give birth, the safest setting for birth is a hospital or an accredited birthing center. Women considering home birth need to be informed about risks and benefits; specifically, home birth is associated with fewer interventions, although it carries an increased risk for perinatal death and serious neurologic dysfunction in the infant. ACOG stresses the importance of appropriate selection of candidates for home birth. There are advantages of planned home birth. The family is in control of the experience. Serious infection may be less likely, assuming strict aseptic principles are followed, because people generally are relatively immune to their own home bacteria.

Patterns of health care used to assess maternal and fetal health...

initial and follow up visits, follow up visits grow closer together as time of arrival comes closer

intrauterine device (IUD)

is a small T-shaped device with bendable arms for insertion through the cervix into the uterine cavity. Two strings hang from the base of the stem through the cervix and protrude into the vagina for the woman to feel for assurance that the device has not been dislodged. Does not protect against StI.

Multigravida:

woman who has been pregnant more than once